Assessment of the IDF-DAR Fasting Risk Assessment Tool to Predict Type 1 Diabetes-Related Complications During Ramadan in a Real-World Setting

Background: The International Diabetes Federation-Diabetes and Ramadan (IDF-DAR) Practical Guidelines 2021 provide a risk stratification tool to guide the assessment of people with diabetes before they observe Ramadan. Here we conducted a survey study to explore the predictability of the IDF-DAR 2021 guidelines, and the factors associated with breaking fast, in people with type 1 diabetes (PwT1D) during Ramadan. Methods: This cross-sectional study included adult PwT1D living in Saudi Arabia, aged 18 years and above, who observed Ramadan 2022. Between May and August 2022, a standardized online questionnaire was used to collect data regarding socio-demographics, medical history (including the modality of T1D management and other components of the IDF-DAR risk calculator), and Ramadan fasting experience. Results: The study included 963 PwT1D (257 males and 706 females, mean age 26.5 ± 8.4 years). Applying the IDF-DAR risk calculator revealed that the study respondents included 66% high-risk PwT1D, 34% moderate-risk PwT1D (34%), and no low-risk PwT1D. Compared to the moderate-risk group, the high-risk group had significantly more days during which fasting was broken, a higher prevalence of diabetes complications, and more frequent diabetes-related ER visits (P < .01). Attending a pre-Ramadan education session was associated with 47% lower odds of visiting the ER during Ramadan (odds ratio 0.53; 95% confidence interval 0.34-0.82; P = .005). Conclusion: The IDF-DAR 2021 risk calculator predicts the risk of acute diabetes complications and ER visits during Ramadan fasting. Pre-Ramadan education sessions are important and may reduce acute complications among PwT1D during Ramadan fasting.